Quality Strategy
Simply the Best, Every Time:
A strategy for the delivery of outstanding care
2017 – 2020
2
QUALITY STRATEGY 2017 – 2020
1. Introduction
1.1Central London Community
Healthcare (CLCH) provides community
based NHS services across Greater London
and Hertfordshire. We care for around
two million patients with ten million
contacts per year.
1.2CLCH has a strong, thoughtful well
educated and well supported workforce
comprising 3,500 staff from a variety of
professional and technical backgrounds,
all of whom ultimately contribute to
the delivery of best quality care for the
patients we serve.
1.3CLCH Vision, Mission and Values.
Quality is at the heart of everything we
do at CLCH and this is reflected in the five
year Integrated Business Plan (2015-2020)
and supporting strategies. Our mission
and vision were refreshed in 2015 to
reflect the direction of travel outlined in
the ‘NHS Five Year Forward View’ and to
ensure the Trust is well placed to play a
role in new models of care.
Our vision: Great care closer to home
Our mission: Working together to give
children a better start and adults greater
independence
Our Values:
Quality: We put quality at
the heart of everything we do.
Relationships: We value our
relationships with others.
Delivery: We deliver services
we are proud of.
Community: We make a positive
difference in our communities.
QUALITY STRATEGY 2017 – 2020
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1.4This strategy builds upon the highly
successful 2013-2016 Quality Strategy
which raised the profile of the quality
agenda at CLCH and laid down the
building blocks for quality improvement.
The 2013-16 strategy supported
the development of robust systems,
processes and objectives to improve care
and also provided assurance that high
quality care was being delivered and
poor practice identified and rectified at
an early stage.
‘Simply the Best, Every Time’ aims to build
on the success of the first Quality Strategy
and focus particularly on reducing some
of the unwarranted variations in care
which exist across the Trust and also move
the Trust from providing ‘good’ care to
‘outstanding’ care.
This strategy will keep the original
Quality Strategy campaigns but will also
add three new campaigns related to:
the workforce; education and training;
and ensuring value for money, in line
with changes to the national focus
on quality. Feedback from staff and
stakeholders suggested that the Quality
Strategy should be more aligned with
the annual Quality Account and also
focus more on professional issues; both
suggestions have been incorporated
into the strategy.
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QUALITY STRATEGY 2017 – 2020
The significant difference however with
the new strategy is the way in which it
will be delivered. Staff have asked to be
more involved in Trust decisions related to
quality and we are therefore introducing
a model of shared quality governance
throughout the Trust which will not only
provide much improved patient and staff
engagement but also support shared
decision making and responsibility.
1.5There are many strategies and
frameworks within CLCH which relate
to quality and it is important that staff,
patients and stakeholders understand
how they all fit together to support quality
improvement. This strategy is a plan for
how we as a Trust are going to organise
and develop to improve the services we
deliver over the coming three years. Under
each campaign the enabling strategies
that support the work of the campaign
are listed.
1.6The annual Quality Account
will define the Trust’s annual quality
objectives. The annual quality objectives
will be based on the key outcomes
described in this strategy. At least one key
outcome per campaign will be proposed
for inclusion in the account. In this way
the Quality Account will mirror an element
of the Quality Strategy objectives.
2.
The purpose of the strategy
2.1The overall purpose of the strategy
is to secure CLCH’s place as the best
provider of high quality community
healthcare in the country by 2020.
2.2The strategy will ensure that patients and
their families receive an experience that not
only meets but exceeds their expectations
of services at CLCH. It will also enable CLCH
to maintain and increase public confidence
and to sustain its reputation as a healthcare
provider of choice.
2.3It will demonstrate that CLCH is
able to listen and respond to the views
of patients, their families and the local
community to drive service improvements.
2.4The Quality Strategy 2013-16 was led
by the quality division collaboratively with
the operational divisions and staff on the
front line. This strategy aims to empower
staff through ‘staff and patient quality
councils’ to make key organisational
decisions about the ‘way things are done
around here’.
2.5It will provide a clear framework
for the planning, implementation,
evaluation and reporting of quality service
improvements to ensure year on year the
quality of services is improving.
2.6The Quality Strategy 2013-16 started to
change the culture of quality at CLCH. This
strategy aims to further develop and sustain
a culture of delivering outstanding care.
The purpose of the
strategy is to secure
CLCH’s place as the best
provider of high quality
community healthcare
by 2020.
QUALITY STRATEGY 2017 – 2020
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3.
The strategic case for change
Quality at
the heart of
all we do
National
Drivers
Greater
engagement
of staff
Challenging
Economic
Climate
Quality is at the heart of
everything we do at CLCH
Quality at
the heart of and this is reflected in
all we do
the five year Integrated
Business Plan (2015-2020)
and supporting strategies. From front line
to Board we are clear that our primary
purpose is to deliver the best possible
care to the patients and service users we
serve (hereafter referred to collectively as
patients).
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This strategy
incorporates learning
National
from many key reports
Drivers
related to improving
care in the NHS. Within
the health service, there has been
a noticeable change in emphasis in
national publications from focusing
purely on patient experience, clinical
effectiveness and safety to providing
value for money and innovative,
efficient ways of working and this shift
is reflected in the strategy.
QUALITY STRATEGY 2017 – 2020
The Five Year Forward View
The Five Year Forward View (published
In October 2014) set out a new shared
vision for the future of the NHS based
around the new models of care (https://
www.england.nhs.uk/wp-content/
uploads/2014/10/5yfv-web.pdf).
CLCH works across four Sustainability and
Transformation Plan (STP) areas and this
strategy enables us to be clear with our
partners’ organisations, our structure
and direction in relation to quality.
Leading Change, Adding Value (LCAV)
In May 2016, NHS England published
Leading Change, Adding Value (a
framework for nursing, midwifery and
care staff). The document outlined 10
commitments. All of these commitments
have been referenced within the six
campaigns. (See appendix 2 for the
10 commitments). Whilst the national
framework relates only to nursing and
allied health professionals, this strategy
incorporates all clinical and non-clinical
staff across the organisation.
https://www.england.nhs.uk/wpcontent/uploads/2016/05/nursingframework.pdf
Staff and patients are
clear that they want
Greater
engagement to be more involved
of staff
in important decision
making related to quality.
We know that having engaged, motivated
staff leads to better patient outcomes
so we want to be able to engage and
support our staff to provide the best care
they can within the available resources.
The model of shared governance outlined
in this strategy implements 24 ‘quality
staff and patient councils’ to innovate and
drive change.
QUALITY STRATEGY 2017 – 2020
This strategy incorporates
learning from many
key reports related to
improving care in the NHS.
The current challenging
Challenging economic climate means
that we need to do more
Economic
Climate
for less and continue to
improve quality whilst
also reducing costs. It is important that as
a Trust we acknowledge that quality and
finance must walk hand in hand if the
best outcomes are to be achieved for the
patients and citizens we serve. The way in
which health services are now organised
means that patients have the right to
choose where they receive healthcare and
commissioners can purchase that care from
a choice of NHS, private and third sector
providers. New models of care delivery are
being designed and commissioned and
Sustainability and Transformation Plans
(STPs) are being developed which change
the sovereignty of organisations with the
aim of wrapping care around specific
patient groups. We believe that at CLCH
we are best placed to provide community
healthcare to the population we serve whilst
collaborating in the new models of service
delivery. It is therefore essential for the
continued success of the Trust that we are
able to demonstrate that we not only offer
value for money services, but also services
that provide higher levels of quality than
that of our competitors.
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4.
eveloping and sustaining
D
a quality culture
Shared governance and
co-design between staff
and patients
Helping our staff
to become the best
they can be
Outstanding care,
every time
Paying attention
to the little
things
Outstanding care,
every time
Helping our staff
to become the best
they can be
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No secrets, no lies,
increasing openness,
learning and transparency
In our 2015 Care Quality Commission inspection report, staff
were commended for their commitment, and passion for
providing high quality, compassionate care. We want to nurture
this culture of excellence and enthusiasm to ensure the care we
deliver to patients is not just good, but outstanding, every time.
Quality is at the heart of everything we do at CLCH and that
means ensuring that we have well resourced, well-structured,
thoughtful and efficient services run by staff that care
passionately about the patients we serve. Our first Trust strategic
priority confirms our commitment to continuous improvement
in quality. However, staff cannot provide the best care if they
feel undervalued or exhausted. We are therefore committed to
developing a culture where staff are supported, developed and
rewarded for driving and delivering quality improvements and
feel that they are the best they can be.
QUALITY STRATEGY 2017 – 2020
Our first Trust strategic
priority confirms our
commitment to continuous
improvement in quality.
Paying attention
to the little
things
No secrets, no lies,
increasing openness,
learning and transparency
Shared governance and
co-design between staff
and patients
QUALITY STRATEGY 2017 – 2020
Good quality healthcare depends on getting the basics right;
safe, effective harm free care provided wherever possible at
home or as near to home as possible in a clean and pleasant
environment, patients feeling welcome and confident, and
patients being treated with dignity and respect. A high quality
care experience should not be a luxury – we believe that
receiving the right care, in the right place by a well-trained and
supported workforce is every patient’s basic right. We think
that the difference between ‘good’ care and ‘outstanding’
care is paying attention to the little things which make the
greatest difference to patients. We are, therefore developing an
‘outstanding care’ blog within our regular Spotlight on Quality
newsletter where staff can ‘show off’ the little things they do
over and above what they are required to do which makes our
services outstanding.
Things don’t always go to plan and there may be times when
mistakes are made or services fail to perform to the standard
we expect. We believe in having systems in place, which pick
up quickly on any mistakes or problem areas and rectify them
promptly, making sure they don’t happen again. This also
includes being transparent and open with patients and staff –
no secrets, no lies.
We believe that decisions about the quality of care are best
made as near to the patient as possible. By introducing a model
of shared governance, front line staff and patients will be
engaged in the design and delivery of care.
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5.
The six quality campaigns
Fig 1 Simply the Best, Every Time –
Campaigns for Action!
It is paramount that the strategy continues
to create a ‘movement of change’ rather
than instructions for improvement. Staff
have fed back that they like the campaign
structure as it adds energy and dynamism
so the original three campaigns will been
maintained, albeit with a slight change
in emphasis from the old ones, and three
new campaigns added to encompass
changing national and local priorities. The
six campaigns are depicted and described
in Fig 1 below, together with the enabling
strategies for each campaign. Appendix
One outlines the specific outcomes for
each campaign over the three years of
the strategy.
It is paramount that
the strategy continues
to create a ‘movement
of change’ rather
than instructions for
improvement.
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QUALITY STRATEGY 2017 – 2020
Campaign
Description
Campaign One
A Positive Patient
Experience
Changing behaviours and care to
enhance the experience of our
patients and service users
Campaign Two
Preventing Harm
Reducing unwarranted variations
in care and increasing diligence in
practice
Campaign Three
Smart, Effective
Care
Ensuring patients and service
users receive the best evidence
based care, every time
Campaign Four (new)
Modelling the Way
Providing world class models of
care, education and professional
practice
Campaign Five (new)
Here, Happy,
Healthy and Heard
Recruiting and retaining
outstanding clinical workforce
Campaign Six (new)
Value Added Care
Using enhanced tools, technology
and lean methodologies to
manage resources well including
time, equipment and referrals
Lead
Co-ordinating
Council
Enabling
Strategies
LCAV Commitment
(Appendix 1)
Director of Patient
Experience
Patient Experience
Patient and Public
Involvement Strategy
1,3,4,5
Director of Nursing
& Quality
Patient Safety and
Risk
Risk Management
Strategy
Sign Up to Safety
3,4,5,6,9
Medical Director
Clinical Effectiveness
Continuous
Improvement Strategy
Research Strategy
Clinical Framework
3,4,7,8,10
Chief Nurse & Chief
Operating Officer
Education and
Development
Education and
Learning Strategy
6,7,8,9
Director of Human
Resources
Workforce Partnership
People Strategy
Leadership Strategy
Health and Well-being
Strategy
6,8,9,
Medical Director
Strategic Improvement
Information
Management and
Technology Strategy,
Quality, Innovation,
Productivity and
Prevention Strategy
1,2,4,7,9,10
QUALITY STRATEGY 2017 – 2020
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12
QUALITY STRATEGY 2017 – 2020
6.
Delivering the strategy
6.1A Framework for Improvement
CLCH has had in place for some
years a methodology for continuous
improvement. The continuous
improvement strategy, led by the Medical
Director, describes the way in staff are
trained and supported to undertake
change projects. The continuous
improvement strategy also supports the
Trust’s Quality Innovation Productivity
and Prevention (QIPP) programme
The six quality campaigns provide the
overarching framework which will direct
the quality journey over the next 3 years.
However, the way in which staff are
empowered and enabled to design and
deliver the campaign objectives will be key
to its success. The three building blocks
to the success of the strategy are outlined
on the following pages; a framework for
improvement; a model of shared governance;
and the CLCH ladder of excellence.
Fig 2 A Framework for Improvement
LIT Y
15
HEAR IT!
• Engage patients (e.g. listening
events, patient stories)
PC
HA
LL
E
E
TO
TH
DISCUSS IT!
• Clinical supervision
• Team/service meetings
• Shared Governance Councils
• Divisional Boards
• Executive Leadership Team
R
ID
CK
CHANGE IT!
• Quality Action Teams
• Shared Governance Councils
• Continuous Improvement
• Divisional action plans
AY
S
• Identify issues, themes and trends
FR
BA
OO
• Review patient & staff feedback,
complaints, incidents, PALs,
surveillance and quality data
4 Better outcomes
4 Better experiences
4 Better use of resources
•S
hare widely & celebrate success
FL
ANALYSE IT!
SIMPLY THE BEST,
EVERY TIME
AL
EVALUATE IT!
I
C
SP
• Capture data on quality
•E
nsure changes are implemented
and achieve desired results
E
STE
• Engage staff (e.g. Shared Governance,
Continuous Improvement)
OT
IG
HT
ON
A
QU
NG
L
S E E IT
IN
CL
V IS A B L E L E A D E R S H I P
QUALITY STRATEGY 2017 – 2020
13
and transformation work. It makes
sense that the model of continuous
improvement is used by staff when they
are implementing quality improvements.
The continuous improvement strategy
incorporates Demming’s OPDSA
(Observe, Plan, Do, Study, Act) cycle
as a core method for making change.
The framework for improvement in fig.
2 incorporates the OPDSA cycle and
the quality activities associated with
the Quality Strategy and describes the
‘quality movement’ which will drive the
improvements outlined in this strategy.
6.2Shared Governance
6.2.1 Shared governance (as defined
by the shared governance taskforce
USA 2014) is a dynamic staffleader partnership that promotes
collaboration, shared decision making
and accountability for improving quality
of care, safety, and enhancing work
life. Models of shared governance first
started in the USA over 30 years ago
but it is now a methodology for creating
and sustaining well led, engaged
organisations across the world. It is
clear from a plethora of evidence that
empowering front line staff to make
patient focused change has visible
benefits to patient and staff outcomes
and feedback.
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QUALITY STRATEGY 2017 – 2020
6.2.2 Shared governance models vary
across healthcare organisations and we
have chosen to use a model of shared
governance to support the delivery of
the Quality Strategy. All current shared
governance models both nationally
and internationally bring front line staff
together to make decisions related to
the delivery of care but at CLCH we have
uniquely decided to also include patients
and members of the public in our model
of shared governance.
6.2.3 Each operational division will form a
‘quality council’ for each of the six quality
campaigns. The council will be chaired
by a member of staff more junior than a
Band 7 and will comprise of approximately
ten members of staff from across
professions and grades and two patients
or members of the public. The proposal is
for the councils to be implemented using
a phased approach, so in year one, three
councils would be developed in each
division followed by an evaluation and
changes as required. In year two, further
councils would be implemented with the
aim of all six councils being in place within
each division by year three.
6.2.4 The council will have two key
functions. Firstly, each quality council will,
working within clear guidance, decide on
one objective for their division related to
their particular council. In order to choose
an objective they will be supported with
information and data from the corporate
teams. They will then work on that
objective throughout the year, pulling in
support where needed from colleagues
across their division and across the Trust.
Secondly, they will act as a resource for
other front line staff, colleagues and
managers to give informed opinions/
advice on issues. For example, it may be
that the Chief Nurse is not sure how to
take a particular problem or issue forward
and she requests the advice of one of the
quality councils. Alternatively front line
staff may want to ask the opinion of one
of the quality councils.
6.2.6 Each council chair will feed into
the coordinating council for their
division, led by the Associate Director
of Quality (ADQ), and also into the
Trust wide coordinating council for their
campaign, thus creating a community
of learning across the organisation.
The Trust coordinating councils will
then feed into the Quality Committee,
Workforce Committee or Finance,
Resources and Investment Committee as
appropriate and the Trust Board.
6.2.5 Clear boundaries and parameters
will be set in order for the councils to
function well and for their members to
feel supported and empowered. Training
will be given to the chairs of the councils
and also to the council members as a
whole. It has not yet been decided how
the councils will be elected or chosen but
the newly appointed quality fellows (Band
5 to 6 fast track staff) and graduates of
the continuous improvement programme
will be expected to be fully involved, if not
chair one of the quality councils.
QUALITY STRATEGY 2017 – 2020
15
16
C6
Divisional
Quality
Co-ordinating
Council
C3
C4
C5
C6
Divisional
Quality
Co-ordinating
Council
Campaign Three
Smart, Effective Care
Campaign Four
Modelling the Way
QUALITY STRATEGY 2017 – 2020
Campaign Five
Here, Happy,
Healthy and Heard
Campaign Six
Value Added Care
Divisional
Quality
Co-ordinating
Council
C6
C5
T6 Strategic
improvement
T5 Recruitment
and retention
T4 Education and
professional practice
T3 Clinical
effectiveness
T2 Patient
safety & risk
T1 Patient
experience
Finance Resources &
Investment Commitee
Board committees
Trust co-ordinating councils
Divisional co-ordinating councils
(reporting into Divisional Board)
Quality councils
ELT
C
Key
Trust Quality Co-ordinating Council
Divisional
Quality
Co-ordinating
Council
C6
C5
C4
C3
C2
C1
CH
Workforce
Commitee
C5
C4
C3
C2
C1
N
Quality
Commitee
C4
C3
C2
C2
Campaign Two
Preventing Harm
C1
I
C1
S
Campaign One
A Positive Patient
Experience
Quality Campaigns
Fig 3 Quality Strategy Governance Structure
Trust Board
6.3CLCH’s Steps to Excellence
Things don’t always go to plan and
we know that the best meaning staff
and teams can go through periods
of challenge and performance can
drop. Over the next 3 years we are
concentrating on not only being able to
identify at an early stage when things
are going wrong, but also putting in a
support structure to turn around poor
practice and celebrate outstanding care.
We have found that sometimes teams
who have gone through difficult times
and where we have put in extra support
to turn them around, have not just
stopped poorly performing but have in
fact become exemplar sites. With this
in mind, we have designed a ladder of
excellence. Some teams may start at
the bottom of the ladder, others nearer
the top but the belief is that, wherever
you start, you always have the ability
to reach the top and become a Quality
Development Unit. Quality Development
Units will be reassessed annually.
Quality
Development
Unit
Fig 4 Ladder of Excellence
Present to
Quality Panel
Implement quality
improvements
Quality Inspection
Team
CQC
self-assessment
Quality Action
Team
Red flag
system
QUALITY STRATEGY 2017 – 2020
17
A monthly list is produced which highlights services which either
do not meet two of the key six criteria or who have not met one
criteria for more than one month. The six criteria are:
Red flag
system
No leader for 2 months or more
Vacancies over 12%
Sickness
A reported serious incident
An increase in incidents causing harm
Increase in complaints
Once a team has been identified, an assessment is made by the
ADQ to identify if there needs to be a quick intervention, if the
team are already working on the problem (e.g. they have recruited
staff that are soon to start) or if they are struggling and need the
support of a Quality Action Team.
Quality Action
Team
CQC
self-assessment
18
Quality Action Teams (QATs) are formed to support a team or
service which is having problems and has been identified on the
red flag list. A QAT is led by an ADQ or member of the quality
division and includes experts and front line staff. The QAT develops
and implements an action plan for improvement with the aim of
rectifying current issues and moving forward to excellence.
Each service in CLCH is required to complete a CQC selfassessment annually which enables them to assess their
standards of service and care against the CQC requirements.
These assessments are then discussed within their division
and sent to the central compliance team together with their
action plans for improvement.
QUALITY STRATEGY 2017 – 2020
Depending on the results of the self-assessment, Quality
Inspection teams carry out inspections of services, similar
to a CQC inspection and support staff to further improve
on their self-assessment scores.
Quality Inspection
Team
Teams can use the CLCH continuous improvement methodology
to monitor their progress against the 6 quality campaigns,
testing and implementing changes to continuously improve
their service.
Implement quality
improvements
Present to
Quality Panel
Quality
Development
Unit
Once a team has achieved excellent results in their selfassessments, quality indicators and Quality Inspection team
visit, they can apply to the Quality panel to become a Quality
Development Unit. The panel will comprise members of the
Trust Board, external stakeholders and peers.
Quality Development Unit (QDUs) status will only be awarded to
teams/services who have shown excellence in quality through the
assessments above. They will be held up as centres of excellence
within the Trust and will receive a team award and each team
member will be given a lapel badge. The QDUs will be expected
to trial new ways of working, offer advice to other teams who
are struggling and play a prominent role in the quality councils.
QUALITY STRATEGY 2017 – 2020
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7.
Reporting and communicating
7.1A set of quality key performance
indicators will continue to be monitored
from front line to Board and a Quality
Report will be presented quarterly to
the Quality Committee and Trust Board
outlining the progress of the Quality
Strategy objectives (Appendix 1). An
annual report will be produced which will
form part of the annual Quality Account.
7.2Progress on the campaigns will be fed
up through the shared governance model
(fig 3 page 16).
7.4Ongoing involvement in the Strategy
is key to its success and it is expected
that by incorporating the objectives
throughout the divisions and into
individuals’ personal objectives, the
Strategy will maintain the energy and
enthusiasm with which it has been driven
to date by all those involved.
7.5Spotlight on Quality is a popular
monthly publication through which quality
updates and news are shared across the
organisation. This will also be used to be
publicise the Strategy.
7.3It is essential that this Strategy is
communicated as widely as possible to our
stakeholders and importantly our patients
and our staff. The Trust communication
team will work with the quality directorate
to include the Strategy in the transformation
communication programme.
We have opportunities
and responsibilities to
make a difference in
narrowing these gaps no
matter where we work.
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QUALITY STRATEGY 2017 – 2020
8.
Resources
8.1It is recognised that the Trust will need
to invest in resources to implement the
strategy and shared governance model.
8.2As identified in Leading Change,
Adding Value: without efficiencies,
a shortage of resources will hinder
care services and progress. We have
opportunities and responsibilities to make
a difference in narrowing these gaps no
matter where we work. What is important
is that we understand where we need to
align our efforts to undertake activities
that are of high value.
8.3Analysing unwarranted variations in
care is vital in ensuring that the right care
and support is delivered for everyone at a
consistently high standard. Unwarranted
variation can be a sign of waste, missed
opportunity and poor quality and can
adversely affect outcomes, experience
and resources. We need to know where
to look for unwarranted variation, what to
change and how to change it. That means
understanding differences in how services
are provided, the outcomes they achieve
and what they cost.
QUALITY STRATEGY 2017 – 2020
8.4The notion of unwarranted variations
in care is a helpful way to focus on
delivering the right care in the right
place at the right time. There are some
reasons why health and care outcomes
may vary over which we have no control.
Unwarranted variations are those which
we could change if we chose to. They
can be a sign of poor quality care, missed
opportunities and waste and can result in
poorer outcomes, poorer experience and
increased expense.
8.5Phasing of Shared Governance
Programme
The aim is for each division to initially
implement the Divisional Quality Council
(chaired by the ADQ) in order to support
the development and implementation
of the quality councils within the
division. The proposal will then be for
the Divisional Quality Councils to be
implemented using a phased approach,
so in year one three councils would be
developed in each division followed by
an evaluation and changes being made
as required. In year two, further councils
would be implemented with the aim of
all six councils being in place within each
division by year three.
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8.6Costs
It is recognised that there will be
some resources required to support
the effective implementation of the
Divisional Quality Councils. This includes
the training required for chairs, Quality
Improvement leads and patients within
each council and the back fill required
for the chairs. The training programme
for these individuals is currently being
developed in order to establish how this
can be delivered with existing resources.
The aim is for the Quality Councils
to take place once per month and
therefore for the members, it is
not envisaged that there would be
additional costs incurred. However,
for the Chairs of each council, there is
recognition that to effectively undertake
the role approximately 1 day per
month will be needed to prepare and
manage the councils. The Trust Shared
Governance Steering group is currently
reviewing this in order to establish how
this can be supported. In addition, the
incentive for patient members is being
explored in order to ensure that they
feel recompensed for their time and
contribution to the Trust.
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QUALITY STRATEGY 2017 – 2020
9.
hat will affect the
W
success of the strategy?
9.1The Trust will continue to be
monitored by the Care Quality
Commission. The Trust has pledged
to seek to improve on the individual
domain ratings issued by the CQC in
August 2015. The intention is to strive
for ‘Outstanding’ in all 26 areas where
‘Good’ was achieved and to achieve at
least ‘Good’ in all 4 areas rated ‘Requires
Improvement’.
9.3The new model of shared governance
carries with it some risk. We have an
ambitious timetable for implementation
with very little additional resource. Year
one of the strategy will see the three
chosen Quality Councils in shadow form
to allow them to grow and develop and
it is expected that by 2020 there will be
a thriving, highly effective network of
quality councils.
9.2Without a workforce for the
future that is appropriately trained and
supported it will be impossible to provide
high quality services. The workforce
objectives are within the Trust People
Strategy and therefore do not feature in
this strategy.
9.4We are working closely with our
commissioners to ensure that, through
the CQUIN initiatives, key performance
indicators and quality monitoring groups,
we are meeting the quality expectations
of the populations we serve.
Without a workforce that
is appropriately trained
and supported it will be
impossible to provide high
quality services.
QUALITY STRATEGY 2017 – 2020
23
10.
And finally
The Quality Strategy provides us with a
framework through which improvements
in the services we offer to patients can
be focused and measured. We have
taken time to listen to our patients,
public and staff about the things that
really matter to them; we have also
considered the national picture including
the requirements of the Five Year Forward
View and Leading Change, Adding Value
and have addressed all these issues within
this updated strategy.
The Quality Strategy is supported by
a strong organisational philosophy of
changing culture and improving services
to meet our patients’ needs and ensuring
our staff feel valued and involved,
thus continuing to make our Trust, the
healthcare provider of choice both for
commissioners and the patients and
communities we serve.
24
QUALITY STRATEGY 2017 – 2020
QUALITY STRATEGY 2017 – 2020
25
Quality Campaigns –
Measures of success
Appendix 1
Campaign One:
A Positive Patient Experience
Changing behaviours and care to enhance the
experience of our patients and service users
Lead: Director of Patient Experience
Supporting strategy: PPE Strategy
Co-ordinating council: Patient Experience
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
Service developments and plans
of care co-designed with patients
and service users
Maintenance of 90% and
above of proportion of patients
whose care was explained in an
understandable way
92% or above of proportion of
patients whose care was explained
in an understandable way
95% or above of proportion of
patients whose care was explained
in an understandable way
90% of proportion of patients
who were involved in planning
their care
92% or above proportion of
patients who were involved in
planning their care
The use of co-design will be
evaluated across the organisation
All service improvement
projects will be supported
through co-design
Achievement of 85% of
proportion of patients who were
involved in planning their care
The use of co-design will
be embedded throughout
the organisation
Patients will be members of the
Quality Councils in each division
Patient stories and diaries used
across pathways to identify touch
points and `Always events’
Always Events will be
implemented across the Trust
Continued use of patient stories
by all services and shared at
Divisional and Trust forums
Develop a plan to implement
patient diaries in services and
how these can be used to inform
service improvement.
Implement patient diaries into
identified services
Evaluation from patient feedback
of their involvement in the
Quality Councils
Evaluation of Always Events
and their impact on patient
experience
Quality Councils to start leading
on the development of Always
Events with local implementation
Thematic analysis of previous
year’s stories with shared learning
Continued use of patient stories
by all services and shared at
Divisional and Trust forums
Evaluation of patient diaries and
the impact on patient experience
26
QUALITY STRATEGY 2017 – 2020
Patients will be members of the
Quality Councils in each division
Always Events to become
integral to Quality Councils as a
method used to improve patient
experience
Evaluation of Always Events
and their impact on patient
experience
Thematic analysis of previous
year’s stories with shared learning
Continued use of patient stories
shared at Divisional and Trust
forums
Patient diaries embedded into
services as a method for involving
patient feedback into service
improvement
Patient stories and
feedback will be integral
to the learning from
serious incident reviews.
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
Patient feedback used to inform
staff training
Implement patient feedback
into the Trust Education forum
through the use of complaints/
PALs and patient stories
Patient feedback will be integral
to the review and development
of education and training
Patient feedback will be integral
to the review and development
of education and training
Evaluate how patient feedback
has influenced training and
education
Patient stories and feedback will
be integral to the learning from
serious incident reviews
Identify opportunities for patients
and carers to participate in training
Develop and implement patient
stories as part of the learning
from serious incident reviews,
for example impact of a pressure
ulcer/ fall.
Evaluate the use of patient stories
as part of learning from serious
incident reviews
Patients to be members of the
Quality Councils for education
and training
Divisional Quality Council
Objectives
QUALITY STRATEGY 2017 – 2020
One objective with
outcome measures
Two objectives with
outcome measures
Three objectives with
outcome measures
27
Campaign Two:
Preventing Harm
Reducing unwarranted variations in care
and increasing diligence in practice
Lead: Director of Nursing & Quality
Supporting strategy: Risk Management Strategy
Co-ordinating council: Patient Safety and Risk
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
Systems in place to provide early
warning to illness, service failure or
a reduction in the quality of care
Maintenance of 98% or > harm
free care
Maintenance of 98% or > harm
free care
Maintenance of 98% or > harm
free care
Severity of Pressure Ulcers (PU)
and falls will continue to fall (5%)
Incidence of PU and falls will
continue to fall (5%)
Incidence of PU and falls will
continue to fall (5%)
Red flag reporting will be
embedded throughout
organisation
Red flag evaluation will
take place
Reporting of incidents increases
whilst levels of harm reduce
Reporting of incidents increases
whilst levels of harm reduce
0% PU in bedded areas
Revised early warning system
developed for patients in
community setting including
revised early warning assessments
for falls and pressure ulcers
100% RCA completed on time
0% PU in bedded areas
100% RCA completed on time
0% PU in bedded areas
100% Root Cause Analysis (RCA)
completed on time
Safety culture and activities
signed up to in ALL services
Trust maintains good or
outstanding in NHS Improvement
(NHSI) learning from mistakes
league table
Safety culture and activities
signed up to in ALL services
Trust maintains good or
outstanding in NHSI learning
from mistakes league table
Quality Action Teams (QAT)
develop areas to exemplars
All staff using repository
in practice
No outstanding actions from SI
All risk register actions are met by
identified completion date.
Variations in practice identified
and acted upon
All staff are aware of learning
from incidents
Develop a learning repository
to enable teams and services
to share lessons identified from
incidents 2017/18, evaluate the
use of the repository and its
effectiveness 2018/19
Divisional Quality Council
Objectives
28
One objective with
outcome measures
QUALITY STRATEGY 2017 – 2020
Two objectives with
outcome measures
Three objectives with
outcome measures
Campaign Three:
Smart, Effective Care
Ensuring patients and service users receive
the best evidence based care, every time.
Lead: Medical Director
Supporting strategy: Continuous improvement
Co-ordinating council: Clinical Effectiveness
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
Clinical staff use the most up to
date clinical practices
Central Alerting System (CAS)
alerts inc. Patient Safety Alerts
(PSAs) – Monthly Board KPI target
for timely alert closure ≥90%
CAS alerts (inc. PSAs) – Monthly
Board KPI target for timely alert
closure ≥90%
CAS alerts (inc. PSAs) – Monthly
Board KPI target for timely alert
closure ≥90%
NICE – 80% of services complete
a Baseline Assessment Form for
NICE Guidance within the agreed
timeframe
NICE – 90% of services complete
a Baseline Assessment Form for
NICE Guidance within the agreed
timeframe
National Institute for Health and
Care Excellence (NICE) – 75%
of services complete a Baseline
Assessment Form for NICE
Guidance within the agreed
timeframe
There will be demonstrable
culture of clinical enquiry and
continuous improvement across
the Trust
76% staff able to contribute to
improvements at work
(staff survey)
78% staff able to contribute to
improvements at work
(staff survey)
80% staff able to contribute to
improvements at work
(staff survey)
Staff to have access to analytics
training, tools and support via
the intranet
Central resource dedicated to
improvement analytics
80% staff reporting they have
access to improvement analytics
when required
CLCH will be a leader in
innovative community practice
Develop a learning repository for
lessons learnt regarding change
projects
Each Division to identify within
business planning process an
innovation for 2018/19
Project initiation documents
(PIDs) documents to include
section for on-going learning
Research activity increased by 5%
Each Clinical Business Unit (CBU)
identifies within business plan
an innovation for 2019/20 or
describes why would not be
applicable
One objective with
outcome measures
Two objectives with
outcome measures
Divisional Quality Council
Objectives
QUALITY STRATEGY 2017 – 2020
Increased research
activity sustained
Three objectives with
outcome measures
29
Campaign Four:
Modelling the Way
Providing world class models of care,
education and professional practice
Lead: Chief Nurse & Chief Operating Officer
Supporting strategy: Education and Training
Co-ordinating council: Education and Development
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
New roles and career pathways
are in place which supports the
needs of patients/service users
The development of clear
career pathway frameworks for
Bands 1-9 for all services and
staff groups with associated
competencies and skills required
Reduction of vacancy rates across
the Trust (10%)
Reduction of vacancy rates (8%)
The continued implementation of
Apprenticeship roles
The continued pilot of the Nurse
Associate role in Adults and
Children services
The continued pilot of the Capital
Nurse Foundation rotation
programme
The implementation of the
staffing models into all clinical
services following the safer
staffing review
The evaluation of existing
fast track programmes
and the development and
implementation of further fast
track programmes
Each clinical profession has a
clear and successful model of
professional practice which
includes their role in improving
population health as health
champions
Research and develop a model
of professional practice for
clinical staff
Improved staff turnover across
the Trust (10%)
The continued implementation
of Apprenticeship roles
The evaluation of the Nurse
Associate pilots in Adults and
Children services
The evaluation of the Capital
Nurse Foundation rotation
programme pilots
Improved staff turnover (8%)
The continued implementation
of Apprenticeship roles
Staff survey results
Rotation programmes
implemented across the Trust
The implementation of the Nurse
Associate role across the Trust
The evaluation of the staffing
models in all clinical services
Staff survey results
Evaluation of fast track
programmes
Implement and evaluate a model
of professional practice for
clinical staff across the Trust
Evaluate the model of
professional practice
Staff survey results
Reduction of vacancy rates
across the Trust to below 8%
Improved staff turnover
across the Trust to below 8%
30
QUALITY STRATEGY 2017 – 2020
Clinical staff are well led,
educated, trained and
involved in research.
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
Clinical staff are well led,
educated, trained and involved in
research to evidence the impact
of what they do
Increase the number of research
projects involving / led by clinical
staff within the Trust
Increase the number of research
projects involving / led by clinical
staff within the Trust
Increase the number of research
projects involving / led by clinical
staff within the Trust
Two objectives with
outcome measures
Three objectives with
outcome measures
Raise the profile of research in
the Trust in conjunction with the
training and education available
to staff and the career pathway
mapping
Review the Trust’s
research strategy
Divisional Quality Council
Objectives
QUALITY STRATEGY 2017 – 2020
One objective with
outcome measures
31
Campaign Five:
Here, Happy, Heard and Healthy
Recruiting and retaining an outstanding workforce
Lead: Director of Human Resources/OD
Supporting strategy: People/Wellbeing
Co-ordinating council: Workforce
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
Staff are fully engaged and
involved in the model of shared
governance
Three Quality councils per
division are established and
well attended.
Four to five Quality Councils are
established per division and well
attended.
Six Quality Councils are
established per division and
well attended.
Evaluation of the model used
and any changes made
to support the effective
management of the councils.
Shared governance forums
are effective at resolving issues
and concerns
Shared governance becomes
part of “the way we do things”
at CLCH
Voluntary staff turnover
below 10% by 2020
Voluntary staff turnover below
15% (12% by March 2018)
Voluntary staff turnover
below 10%
Voluntary staff turnover
below 8%
Staff vacancies below 10%
by 2020
Staff vacancy rate below 15% by
3/17 and 12% by March 2018
Staff vacancy rate below
10% by March 2018
Staff vacancy rate below
8% by March 2020
Staff surveys are undertaken
which demonstrate improving
levels of staff engagement
Staff engagement index score
of 3.88 or above
0.5+ on staff engagement index
compared to the average for
other community Trusts nationally
Above 0.5% on staff
engagement index compared to
the average for other community
Trusts nationally
Wellbeing strategy to support
staff health and well-being and
reduce staff absence
A 2% reduction in the number of
staff who report feeling unwell as
a result of work related stress in
the 2017 Staff Survey
A 3% reduction in the number of
staff who report feeling unwell as
a result of work related stress in
the 2018 Staff Survey
A 4% reduction in the number of
staff who report feeling unwell as
a result of work related stress in
the 2019 Staff Survey
Sickness absence remains below
target of 4%
Sickness absence remains below
target of 3.5%
Sickness absence remains below
target of 3%
The Trust meets its targets
relating to agency spend
Agency spend is proportionally
reduced as sickness, turnover and
vacancy rates reduce
Agency spend is proportionally
reduced as sickness, turnover and
vacancy rates reduce
The number of staff recruited to
staff bank increases by 15%
The number of staff recruited to
staff bank increases by 20%
Two objectives with
outcome measures
Three objectives with
outcome measures
The Trust is committed to and
makes demonstrable reductions
to agency spend
Divisional Quality Council
Objectives
32
The number of staff recruited to
staff bank increases by 10%
One objective with
outcome measures
QUALITY STRATEGY 2017 – 2020
Campaign Six:
Value added care
Using enhanced tools, technology and lean
methodologies to manage resources well including
time, equipment and referrals.
Lead: Medical Director
Supporting strategy: IM&T and QIPP
Co-ordinating council: Strategic Improvement
Key Outcomes
Measures of success
2017 – 2018
Measures of success
2018 – 2019
Measures of success
2019 – 2020
The user experience across
CLCH, primary care, specialist
services and social care is as
seamless as possible
Divisions to assess experience
through patient and user
involvement
Implement actions
from assessment
Continued assessment of patient
pathway is embedded
in divisional planning
Clinical staff use the latest
technology to improve care
delivery
Each division has explored how
technical innovation can be used
to improve quality
Each Division to identify within
business planning process an
innovation for 2018/19
Each division has used
improvement tools to improve
one service
Each division has used
improvement tools to improve
1% of services
Front line staff lead new lean
ways of working
5% staff to have been trained to
basic level in improvement skills
including lean
10% staff to have been trained
to basic level in improvement
skills, including lean
15% staff to have been trained
to basic level in improvement
skills , including lean
Divisional Quality Council
Objectives
One objective with
outcome measures
Two objectives with
outcome measures
Three objectives with
outcome measures
QUALITY STRATEGY 2017 – 2020
Patient involvement is the norm
Each CBU identifies within
business plan an innovation
for 2019/20 or describes
why would not be applicable
Each division has used
improvement tools to improve
5% of services
33
Closing the gaps:
Appendix 2
10 commitments to support action of nursing,
midwifery and care.
Extract from
Leading Change, Adding Value (ACAV)
The framework offers 10 aspirational commitments
to help focus on narrowing the three gaps, address
unwarranted variation and help demonstrate the
Triple Aim outcomes.
They are designed to be applied locally in any
environment and at any level.
Commitment
1.
We will promote a culture where improving the population’s health is a
core component of the practice of all nursing, midwifery and care staff
2.
We will increase the visibility of nursing and midwifery leadership
and input in prevention
3.
We will work with individuals, families and communities to equip them
to make informed choices and manage their own health
4.
We will be centred on individuals experiencing high value care
5.
We will work in partnership with individuals, their families,
carers and others important to them
6.
We will actively respond to what matters most to our staff and colleagues
7.
We will lead and drive research to evidence the impact of what we do
8.
We will have the right education, training and development to enhance
our skills, knowledge and understanding
9.
We will have the right staff in the right places and at the right time
10.
We will champion the use of technology and informatics to improve
practice, address unwarranted variations and enhance outcomes
34
QUALITY STRATEGY 2017 – 2020
Health &
Wellbeing
Care and
quality
Funding and
efficiency
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
Notes
QUALITY STRATEGY 2017 – 2020
35